News for Newborns! TennCare Newborn Presumptive Eligibility (NPE) Presentation to the Tennessee Hospital Association August 8, 2014
FFM Challenges Federally-facilitated marketplace (FFM) having difficulties with eligibility. Particularly true for non-TennCare moms. When presenting for delivery, these women are often: ◦ Uninsured; or ◦ Enrolled in CoverKids. 2
New Options for Providers Newborn Presumptive Eligibility (NPE) : ◦ NPE for uninsured newborns; and ◦ Streamlined birth reporting for CoverKids. New option for emergency TennCare. 3
NPE Process Uninsured applicant completes one-page NPE form for newborn at qualified entity (QE) . Applicant must sign and date NPE form. QE employee: ◦ determines NPE on basis of info on form; and ◦ shall then sign and date NPE form. 4
When is NPE Period Effective? Coverage effective on Date of APPLICATION, not simply DOB. (Oh my.) 5
Qualified Entities (QEs) QEs limited to hospitals and birthing centers only. QEs shall comply with responsibilities and State requirements (more below) . QEs must have legal agreements and SFTP2 access with TennCare (more below) . 6
Helping with NPE Form QE employees can assist with NPE form. Common questions: ◦ What counts as income? ◦ Who counts toward household size? ◦ Is SSN for mother or newborn required? ◦ Which MCO to choose? ( ahem! ) Instructions (on back of NPE form) , training materials, and FAQs will help. 7
Determining NPE QE employees ( not contractors) compare: ◦ self-attested household income on NPE form to ◦ TennCare limit for that household size. Income table is on form instructions (on back of NPE form). 8
QE Responsibilities QE shall ensure that: Employees are appropriately trained. Applicants & employees complete NPE form. Employees explain: ◦ If approved, applicant must apply at FFM by end of next month (or lose eligibility); and ◦ If denied, applicant can apply for TennCare and other programs at healthcare.gov. 9
QE Responsibilities (cont’d) QE shall: Give applicant full application after making determination. Promptly submit approvals to TennCare. Maintain NPE form for seven (7) years. 10
NPE Submission Process Fax NPE forms during August. Transition to submission of Daily Newborn Spreadsheet via SFTP2 by Labor Day. Newborn’s eligibility will appear in TennCare Online Services within several days. 11
Birth Reporting for CoverKids Mothers in CoverKids (CK) report birth by phone to CK. CoverKids enrolls newborn in CK or NPE- TennCare. Effective date for NPE is date on which birth reported. 12
Emergency TennCare Alternative Who gets emergency TennCare? CoverKids as alternative for pregnant women. Woman must apply by date of delivery to cover delivery. Expedited application process for hospitals/birthing centers. 13
Next Steps Legal Agreements Technology Training 14
Legal Agreements with QEs TennCare must have a Trading Partner Agreement (TPA) and a Business Associate Agreement (BAA) with each QE. ◦ We already have TPAs with many, so for these we only need a BAA (Form 1) . ◦ For others, we need a TPA (Form 2) and a new BAA (Form 3) . 15
Legal Agreements (cont’d) Distributing list noting which form required for each hospital (along with forms) . Contact andrei.dumitrescu@tn.gov or call 615-507-6855 with questions. 16
Technology Needs QEs will need SFTP2 server access to post “Daily Newborn Spreadsheet”. Hospitals with TPAs already transmit data to TennCare using similar approach. Distributing SFTP2 server access instructions. Contact don.oaks@tn.gov or call 615- 507-6334 with questions. 17
Training Front-Line Staff Webinar next Wednesday (Aug. 13 th ) at 9:30 am CT. Step-by-step guide to determine the right course of action for each patient. Visit www.tenncaretopics.com for FAQs, taped webinar and more information. 18
Stump the Chump! Ask questions now… …or email brian.haile@tn.gov. 19
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